{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T02:48:13Z","timestamp":1767926893306,"version":"3.49.0"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,7]]},"abstract":"\nObject<\/jats:title>\nThe Revision Quotient (RQ) has been defined as the ratio of the number of CSF shunt revisions to the number of new shunt insertions for a particular neurosurgical practice in a unit of time. The RQ has been proposed as a quality measure in the treatment of childhood hydrocephalus. The authors examined the construct validity of the RQ and explored the feasibility of risk stratification under this metric.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe Kids' Inpatient Database for 1997, 2000, 2003, 2006, and 2009 was queried for admissions with diagnostic codes for hydrocephalus and procedural codes for CSF shunt insertion or revision. Revision quotients were calculated for hospitals that performed 12 or more shunt insertions annually. The univariate associations of hospital RQs with a variety of institutional descriptors were analyzed, and a generalized linear model of the RQ was constructed.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThere were 12,244 admissions (34%) during which new shunts were inserted, and there were 23,349 admissions (66%) for shunt revision. Three hundred thirty-four annual RQs were calculated for 152 different hospitals. Analysis of variance in hospital RQs over the 5 years of study data supports the construct validity of the metric. The following factors were incorporated into a generalized linear model that accounted for 41% of the variance of the measured RQs: degree of pediatric specialization, proportion of initial case mix in the infant age group, and proportion with neoplastic hydrocephalus.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe RQ has construct validity. Risk adjustment is feasible, but the risk factors that were identified relate predominantly to patterns of patient flow through the health care system. Possible advantages of an alternative metric, the Surgical Activity Ratio, are discussed.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.3.peds13618","type":"journal-article","created":{"date-parts":[[2014,4,25]],"date-time":"2014-04-25T14:10:50Z","timestamp":1398435050000},"page":"48-54","source":"Crossref","is-referenced-by-count":12,"title":["Quality measurement in the shunt treatment of hydrocephalus: analysis and risk adjustment of the Revision Quotient"],"prefix":"10.3171","volume":"14","author":[{"given":"Joseph H.","family":"Piatt","sequence":"first","affiliation":[{"name":"Nemours Neuroscience Center, A I duPont Hospital for Children, Wilmington, Delaware;"},{"name":"Departments of Neurological Surgery and Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina E.","family":"Freibott","sequence":"additional","affiliation":[{"name":"Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds13618","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"392","DOI":"10.3171\/2013.1.PEDS12362","article-title":"Quality measures for the management of hydrocephalus: concepts, simulations, and preliminary field-testing. 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Clinical article","volume":"4","author":"Simon","year":"2009"},{"issue":"2 Suppl Pediatrics","key":"b14-peds13618","series-title":"J Neurosurg","first-page":"90","article-title":"In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care","volume":"100","author":"Smith","year":"2004"},{"key":"b15-peds13618","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3171\/2012.10.PEDS12329","article-title":"The assessment of bulging fontanel and splitting of sutures in premature infants: an interrater reliability study by the Hydrocephalus Clinical Research Network. 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